Home-based versus clinic-based self-sampling and testing for sexually transmitted infections in Gugulethu, South Africa: randomised controlled trial

Abstract

Objectives: To test whether more women are screened for sexually transmitted infections when offered homebased versus clinic-based testing and to evaluate the feasibility and acceptability of self-sampling and selftesting in home and clinic settings in a resource-poor community. Methods: Women aged 14-25 were randomised to receive a home kit with a pre-paid addressed envelope for mailing specimens or a clinic appointment, in Gugulethu, South Africa. Self-collected vaginal swabs were tested for gonorrhoea, chlamydia and trichomoniasis using PCR and self-tested for trichomoniasis using a rapid dipstick test. All women were interviewed at enrolment on sociodemographic and sexual history, and at the 6-week follow-up on feasibility and acceptability. Results: 626 women were enrolled in the study, with 313 in each group; 569 (91%) completed their 6-week follow-up visit. Forty-seven per cent of the women in the home group successfully mailed their packages, and 13% reported performing the rapid test and/or mailing the kit (partial responders), versus 42% of women in the clinic group who kept their appointment. Excluding partial responders, women in the home group were 1.3 (95% CI 1.1 to 1.5) times as likely to respond to the initiative as women in the clinic group. Among the 44% who were tested, 22% tested positive for chlamydia, 10% for trichomoniasis, and 8% for gonorrhoea. Conclusions: Self-sampling and self-testing are feasible and acceptable options in low-income communities such as Gugulethu. As rapid diagnostic tests become available and laboratory infrastructure improves, these methodologies should be integrated into services, especially services aimed at young women.

Cervicovaginal Self-Sampling Is a Reliable Method for Determination of Prevalence of Human Papillomavirus Genotypes in Women Aged 20 to 30 Years

“…Analysis of self-sampled cervicovaginal lavage specimens resulted in comparable numbers of hr-HPV detection and showed similar sensitivity compared to gynecologist-taken samples. These results are in line with previous studies that compared self-and clinician-collected specimens to identify women with a risk of high-grade CIN and cervical precancer (3,5,8,9,10,15). In our study, the self-sampling method was used for the first time in a cross-sectional approach to determine HPV prevalence and genotyping and not to determine a clinical outcome.…”

Acceptability of self-testing for trichomoniasis increases with experience

“…However, analysis of acceptability subscale scores showed that participants perceived self-testing for trichomoniasis as more comfortable than clinician testing, were less confident of their ability to collect/perform the test, and trusted the results less than clinician testing. Two other studies have assessed acceptability of self-testing for STIs 28 29. Adult women in South Africa were randomised to home testing versus clinic-based testing for STIs.…”

Reaching Youth With Out-of-Facility HIV and Reproductive Health Services: A Systematic Review

“…One of these also included school-based implementation for more than half of the study subjects; however, stratified data were not provided, so we were unable to select the non-school-related data of interest to this review. Another two examined outreach strategies, but recruitment into the study depended on and started with health facility access [42,45].…”

“…Twenty-one studies describing results of out-of-facility delivery of health services to youth or populations including youth were excluded (Table 1) [27,30,33,[35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52]; 15 studies were excluded because none of this review's outcomes of interest were measured in those studies. Another three were excluded because the studies did not meet eligibility based on this review's age-ofsubjects criteria.…”